Enabling scale and spread of technology-enabled remote monitoring of blood pressure at home: findings from a rapid qualitative evaluation
Wu F., Moriarty S., Toole H., Wherton J., Mohebbi D., Sheppard J., Shaw S., Marjanovic S.
Background: High blood pressure (BP) is a leading cause of morbidity and mortality. Blood pressure home monitoring improves blood pressure control, but there is limited evidence about the implementation of specifically ‘technology-enabled’ remote monitoring of blood pressure (TERM ) at home. This evaluation aims to improve the evidence base on what constitutes TERM BP services, how they work, and what influences their implementation, impacts, spread, and scale. Methods A multi-method, rapid qualitative evaluation involved four sites that implemented TERM BP. Across sites, we conducted interviews with staff (n=35) and patients (n=15) and analyzed key service documents. Three workshops with site staff, patients, and regional and national stakeholders helped refine the learning process. Thematic analysis and synthesis, and triangulation against existing literature, helped inform recommendations and was guided by the Non-adoption, Abandonment, and challenges to Scale-up, Spread and Sustainability of the technology framework. The patients and public voices informed the evaluation design and conduct. Results TERM BP implementation varies in governance, patient eligibility, technology, workforce, and workflow. Perceived impacts include improved blood pressure control, case-finding, and a more efficient workload distribution. The parallel running of technology-enabled and paper-based pathways mitigates access inequalities, but involves a high administrative workload. Sociotechnical influences on implementation relate to technology user-friendliness and adaptability, health system relationships and resources, practice capabilities and learning cultures, and patient acceptability and enablement. Flexibility within a planned, gradual approach that embeds skills in teams and systems and impacts evidence generation support scale and spread. Conclusions Technology and social forces co-evolve to shape TERM BP pathways and manage co-existing tensions, including planning, emergence, demand, and capacity. Decision makers should establish implementation guidance and commissioning criteria, address regulatory issues, and enable evidence generation and shared learning. Further research is needed on the impact of TERM BP, especially in integrated care and related to inequalities.